Pick a poll, any poll, and run your reform flag up it. Whether your flag is pro or con, somewhere there’s a poll for you. If you have trouble finding it, wait a couple days.
Two public opinion polls released last week — one from CNN, one from Gallup — offered glimpses of how those of us who are not Supreme Court justices feel about health care reform.
While the numbers weren’t that far apart, the headlines were.
Headlines for the CNN poll: “Poll: Majority Now Support The Individual Mandate” and “CNN Poll: Support Rises for Health Insurance Mandate.”
And headlines for the Gallup poll: “Americans Lean Toward Repealing Health Care Reform Law: Gallup” and “Gallup Poll: 47% of Americans Favor Repealing Healthcare Law.”
Details of the Polls
The CNN poll, released Nov. 14 (the same day the Supreme Court announced it would address the issue), indicated growing support for the individual mandate, the fulcrum upon which much of the Affordable Care Act’s clout rests. CNN surveyors found that over the past six months, support for the mandate moved into the majority.
This month, 52% support the mandate and 47% oppose it, according to CNN. A similar survey in June showed 44% supported it, while 54% opposed it. Seniors, low-income residents and independents who changed their minds accounted for the shift, according to CNN pollsters.
Two days later, Gallup released a poll showing that those who want to repeal the law outnumber those who support it. The Gallup poll found 47% want the law eliminated and 42% support it.
Gallup also found that while most Americans prefer a health care system built on private insurance, that majority appears to be shrinking. This month, Gallup surveyors found 56% favor private insurance, compared with 39% who favor a government-run system. Last year, 61% preferred private insurance and 34% said they wanted a government-run system.
CNN’s poll is more recent, has a few more people in it and has a slightly smaller margin of error. But, in most respects, the two polls are twins.
The CNN poll, conducted for the news organization by ORC International Poll, consulted 1,036 American adults by telephone Nov. 11 to Nov. 13, the three days immediately preceding the Supreme Court’s announcement that it will hear challenges to the law. The survey’s overall sampling error is plus or minus three percentage points.
The Gallup poll surveyed 1,012 adults Nov. 3 to Nov. 6 and has a margin of error of plus or minus four percentage points.
Similar in scope and methodology, the two polls did not get equal coverage in the media, nor did experts and bloggers agree on the polls’ meaning. A Google News search for “CNN health reform poll” generates 58 news articles. A search for “Gallup health reform poll” generates 3,033 news articles.
Is Support for Mandate Rising?
According to last week’s New York Times story titled “Insurance Mandate May Be Health Care’s Undoing,” polling over the last few years has shown that the individual mandate is “by far the most unpopular provision” of ACA. Bloggers seem split on what the CNN poll really means for the individual mandate.
On the Times‘ “Conscience of a Liberal,” Paul Krugman writes that support for the individual mandate — “the core of health reform” — in the CNN poll shows that “proponents are slowly winning the argument.”
Meanwhile, Steve Benen, on the Washington Monthly‘s “Political Animal,” interprets the CNN poll as the public’s return to support for the mandate, which he argues “wasn’t especially controversial” in 2009, when the “debate over health care policy began in earnest.”
However, Peter Suderman at reason.com cautions that the increase in support for the mandate could be the result of the poll’s wording. In asking the participants whether they favored the individual mandate, CNN pollsters did not explain that individuals would be fined for failing to comply with the mandate. Suderman also notes that the rise in support for the mandate could be a result of “natural variation in polling results.”
How Involved Should the Federal Government Be?
Gallup’s Frank Newport notes that his organization’s poll showed that majority of respondents believe a private system is better than a public health insurance mechanism. However, half of respondents also said that it is the federal government’s responsibility to ensure all citizens have health insurance. According to Newport, “the issue going forward is the degree to which government should be involved in health care in the years ahead, rather than whether the government should get out of the health care business altogether.”
Similarly, Igor Volsky argues on Think Progress that while ACA itself might not be popular with the public, as indicated by the Gallup poll, some of its individual provisions are. Volsky writes that the individual mandate and private health insurance — such as through state-based exchanges under ACA — “remain popular” among the public.
Volsky also argues that attacks on ACA have “shielded the actual substance from too much disapproval.”
On Business Insider, Larry Elkin urges the Supreme Court to allow cameras in the court during oral arguments on health care reform: “Very few Americans will actually have a chance to watch this ‘closely watched’ case unless the High Court makes a surprising, and unlikely, exception to its ban on live broadcasts of its proceedings.”
Public Opinion and the Supremes
So now, a centuries-old question: Does public opinion have any influence on the Supremes?
About 100 years ago, journalist Finley Peter Dunne‘s fictional alter-ego “Mr. Dooley” summed up the top limb of the judicial branch like this: “No matter whether the country follows the flag or not, the Supreme Court follows the election returns.”
The justices are not immune to news reports, as Robert Field writes in the Philadelphia Inquirer.
To what extent public polling shapes the justices’ opinions has been the subject of scholarly and political debate since presidents began appointing them.
In this instance, however, it may work the other way around — the Supremes may have a big influence on public opinion. Timed to come in the heat of next year’s campaign, the Supreme Court turning thumbs up or down on the Democrats’ most significant legislation in decades will very likely have an impact on who gets the White House and majority status in Congress.
Look for old flags flying on new polls before and — perhaps more importantly — after the Supremes have their say.
In the meantime, here’s a look at what else is happening in health reform.
Administration Actions
- Last week, HHS announced it would delay for one month a decision on Florida’s request for a waiver on the medical-loss ratio rule under the federal health reform law. Under the rule, private insurers must spend at least 80% in the individual market or 85% in the group market of their premium dollars on direct medical costs. The decision had been expected on Nov. 16, one month after the state completed its waiver application. HHS officials said they likely would deliver a decision before the new deadline. HHS has granted full or partial MLR waivers to six states, denied two and is reviewing requests from nine other states (Reichard, CQ HealthBeat, 11/16).
Personnel Watch
- Oregon Insurance Commissioner Teresa Miller has been named a senior adviser for state exchange outreach at HHS‘ Center for Consumer Information and Insurance Oversight. Miller will work with state officials to implement the state-based insurance exchanges, which are scheduled to begin operating in 2014 under the federal health reform law. Miller has been active in the National Association of Insurance Commissioners — which helped formulate the regulations governing the exchanges — and is considered a leading expert on health policy and the exchange program (Baker, “Healthwatch,” The Hill, 11/15).
Eye on the Courts
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In a letter to U.S. Attorney General Eric Holder last week, several Senate Republican leaders asked if U.S. Supreme Court Justice Elena Kagan‘s role as solicitor general in the Obama administration constitutes a conflict of interest in the case against the overhaul. Lawmakers and groups have said that Kagan should not participate in a high court review because she served as U.S. solicitor general in the Obama administration when the law was enacted and the defense of the law and the individual mandate were being prepared. Kagan has denied that there would be a conflict of interest (Haberkorn, Politico, 11/18).
In a letter to the U.S. Judicial Conference last week, 52 Democrats said the U.S. Department of Justice should investigate whether U.S. Supreme Court Justice Clarence Thomas has a conflict of interest because his wife was paid to take part in antireform initiatives. The letter — written by Rep. Louise Slaughter (D-N.Y.) — said Thomas should recuse himself because of the financial disclosure issue and because of “significant conflicts of interest” (Politico, 11/18). - The U.S. Supreme Court has hired H. Bartow Farr and Robert Long, two independent health care lawyers, to argue specific parts of a lawsuit challenging the constitutionality of the federal health reform law (Bravin, “Washington Wire,” Wall Street Journal, 11/18). Last week, the court’s clerk told lawyers for the Obama administration and plaintiffs in the multistate lawsuit that the high court will select independent attorneys to argue positions that likely will not be covered by the two sides (National Journal, 11/16).
- Last week, House Minority Leader Nancy Pelosi (D-Calif.) and Senate Judiciary Committee ranking member Chuck Grassley (R-Iowa) called on the U.S. Supreme Court to accept C-SPAN CEO Brian Lamb‘s request to televise the proceedings of the high court’s review of the federal health reform law next year (Norman, CQ HealthBeat, 11/16). In a letter to Chief Justice John Roberts, Grassley wrote that the case’s “constitutional questions are landmark” and the “public has a right to hear and see the legal arguments” (Vicini, Reuters, 11/15). In a statement, Pelosi said, “When the [health reform law] is placed before the highest court in our country, all Americans will have a stake in the debate; therefore, all Americans should have access to it” (Baker, “Healthwatch,” The Hill, 11/16).
Inside the Industry
- A poll conducted by the Regence Foundation for National Journal found that nearly all physicians said they support medical care services that focus on quality of life for dying patients over efforts to extend patients’ lives for as long as possible. The poll, which surveyed 500 board-certified physicians, found that 96% of respondents emphasize quality of life over length of life and that a similar majority said the U.S. health system should prioritize palliative care services. Eighty-two percent of respondents cited reimbursement as an issue hindering better palliative care (Baker, “Healthwatch,” The Hill, 11/15).
On the Hill
- Last week, the House Energy and Commerce Subcommittee on Health by voice vote approved a bill (HR 1173) that would repeal the Community Living Assistance Services and Supports Act created by the federal health reform law (Zigmond, Modern Healthcare, 11/15). Republicans said the Obama administration’s decision to suspend implementation of the long-term health care program in October is insufficient and it should be formally repealed. Meanwhile, Democrats criticized Republicans for failing to offer an alternative to the program, and Reps. Frank Pallone (D-N.J.) and Edolphus Towns (D-N.Y.) said they plan to offer amendments to block the repeal when the bill is reviewed by the full Energy and Commerce Committee (Pecquet, “Healthwatch,” The Hill, 11/15).
Studying Its Effects
- About 9% of businesses with 500 or more employees said they are “likely” or “very likely” to drop health benefits for their employees in 2014, after state-based insurance exchanges under the federal health reform law become operational, according to a Mercer survey of 2,844 employers (Boulton, Milwaukee Journal Sentinel, 11/16). The survey also found that many employers are concerned about escalating health costs for their workers and are developing strategies to lower costs, such as offering a high-deductible plan with a health savings account (Abelson, “Prescriptions,” New York Times, 11/16).
- Slightly more than half of respondents to a recent survey commissioned by PricewaterhouseCooper‘s Health Research Institute, think that it will be easier to find and purchase health plans through the federal health reform law’s state-based health insurance exchanges. Respondents said they are familiar with concept of the exchanges (Reuters, 11/16).